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Fixing up seniors’ homes to help them age in place

BALTIMORE — Alberta Hough struggles to feed herself a snack, her arms shaking badly from Parkinson’s disease. Days earlier, the 84-year-old had fallen while eating, sliding off her kitchen chair.

The rest of her day isn’t much easier. She wobbles into a bathtub with no grab bar. Her feet catch on damaged tiles. Part of the banister on the stairs has pulled out of the wall. At the back door, a rickety ramp no longer supports the scooter that helps her get around.

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Environment can be as disabling as disease, and too often, older Americans wind up in a nursing home not because they are so ill but because at home they can’t get through their days safely.

A major research project will bring handymen, occupational therapists, and nurses to the homes of 800 low-income seniors in Baltimore to test if some inexpensive fix-ups and strategies for daily living can keep them independent longer, while saving millions in taxpayer dollars spent on nursing home care.

‘‘Very small changes can make a big difference,’’ said Sarah Szanton, a Johns Hopkins University associate nursing professor who leads the project. ‘‘We’re not saying, ‘What’s your blood pressure?’ We’re focusing on function: What do they want to do?’’

Losing independence is a leading fear as people age. But a recent poll shows too few comprehend the changes in lifestyle needed to offset the chronic illnesses and gradual slowdown that hit just about everyone.

Asked about their choice of living situation when they’re older, Americans 40 and over say the priorities are a one-level home with no stairs that’s close to their children and medical care, according to a poll by the AP-NORC Center for Public Affairs Research.

Chances are, that won’t be enough.

For Hough, number one is feeding herself.

‘‘I’m shaking all the time,’’ she told occupational therapist Allyson Evelyn-Gustave.

Hough’s other priority is not falling, and stairs are only one of her home’s hazards.

To Szanton, bridging the gap between what older adults are able to do and what their homes allow them to do is key to maintaining independence.

The Capable study aims to prove how. During 10 home visits over four months, the Hopkins team is tailoring interventions — including about $1,100 in home repairs or modifications provided for free — to help low-income seniors.

Drills buzzed in Hough’s house as carpenters installed a new banister, added grab bars and a raised toilet seat, and replaced patches of flooring.

As for eating, Evelyn-Gustave recommended a little-known tool: utensils and cups that are specially weighted to counter Hough’s tremors.

The set of utensils costs only about $20. Hough’s daughter had thought the only solution was an aide to feed her mother.

The Capable project is being watched by Medicaid officials in other states. With more than $8 million in research money from the National Institutes of Health and the Centers for Medicare and Medicaid Services, the project goes beyond home repair for health. It starts with a full-scale assessment of each participant’s needs.

In one home, a nurse discovered an 82-year-old was taking all of her 26 daily medications at once, leaving her disoriented and sedentary.

An AARP survey in 2010 found that nearly 90 percent of seniors wanted to remain in their current home for as long as possible. Yet government figures show nearly 1 in 5 seniors living in the community have trouble with at least one activity of daily living, such as walking or bathing.

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